8 Tips for Treating Nail Psoriasis

By Leah Campbell
January 07, 2021

Most people think of psoriasis as a condition of the skin, but it can also impact fingernails and toenails. According to board-certified dermatologist Daniel P. Friedmann, M.D. of Westlake Dermatology in Austin, Texas, “Nail psoriasis is extremely common, with up to 50 percent of all patients with psoriasis having some form of nail disease.” This number jumps to approximately 80 percent for people who have psoriatic arthritis, he says.

Friedmann says that nail psoriasis is identified by a series of abnormalities to both the nail and its connection to the underlying skin, which can include:

  • Nail thickening
  • Nail discoloration—a yellow or brown hue
  • Surface irregularities, such as pitting, grooves, or ridges
  • Brittle nails that are prone to fracture
  • Disease of the underlying skin, which can cause significant buildup of debris under the nail, allowing the nail to separate from the skin

Not only do people with these symptoms have cosmetic complaints, but they also may experience pain and an increased risk of infection. Thankfully, there are ways to treat nail psoriasis and prevent additional flares.

Have Your Case Diagnosed

It’s sometimes difficult to tell the difference between nail psoriasis and a fungal infection, according to board certified dermatologist Rhonda Klein, M.D., of Modern Dermatology of Connecticut in Westport, Connecticut. That’s why, she says, “It is important to have it confirmed by a board-certified dermatologist as it can be present and mimic nail fungus, and about 35% of psoriatic nails also have a fungal infection.” These conditions are treated in different ways; so, before you do anything, make sure to first see a doctor.

Consider Your Treatment Options

There are a variety of treatment options available for getting nail psoriasis under control. “High potency topical steroids applied on or around the nail can significantly improve nail psoriasis,” Friedmann explains. “If nail psoriasis is the only external manifestation of the disease, a topical steroid [alone] may be sufficient.”

But some people may need other treatments to help their nail psoriasis. “Given that nail psoriasis is associated with more severe psoriasis, systemic injectable medications that modulate the immune system are often used to control skin disease, nail disease, and joint disease all at the same time,” Friedmann says.

Other treatments used for psoriasis and psoriatic arthritis may be beneficial for nail psoriasis, as well. Those include light therapy and home light box units, according to Klein. Together with your doctor, you’ll create a treatment plan that aligns with your symptoms, severity, health history, preferences, and desired results.

Be Patient

Unfortunately, nail psoriasis doesn’t always clear quickly, and you may need to give a treatment several months before you start to see improvement. In fact, systemic and biologic treatments often reduce psoriasis plaques months before nail improvement is seen, according to the National Psoriasis Foundation. It can take up to a year for impacted nails to be replaced by new nail growth completely.

Avoid Triggers

Klein says that one of the best ways to prevent additional nail psoriasis flares is to avoid your personal lifestyle triggers. “Some common triggers include dairy, gluten, and alcohol, as well as stress and smoking,” she explains. It takes some trial and error and hyper-awareness to determine triggers. It may help to keep a food journal or to try an elimination diet.

Wear Gloves

The American Academy of Dermatology (AAD) recommends people with nail psoriasis wear gloves for any and all manual work, whether you are cleaning your house, washing dishes, working in your yard, or renovating your home. In essence, any activity that might expose your hands to chemicals or strain is best performed with gloves on—ideally cotton gloves with a vinyl or nitrile glove over top, as the AAD says latex gloves are not protective enough.

Practice Gentle Nail Care

Klein says, “Keeping nails short, filed smooth, clean and dry can help prevent associated infections.” It’s also a good idea to treat the nail area gently. The AAD recommends people with nail psoriasis avoid biting and picking at their nails. Never scrape the buildup under your nails (as this can encourage lifting), and skip artificial nails entirely.

If you get professional manicures and/or pedicures, it’ll help to find a technician who is familiar with nail psoriasis. They shouldn’t clip cuticles back or provide aggressive cleaning measures under the nail tip.

Moisturize Often

Because psoriasis can cause drying of both the skin and nails, moisturize with a thick cream or ointment every time you wash your hands and within three minutes of showering or bathing, recommends the AAD. Staying moisturized may prevent symptoms from becoming more uncomfortable or worsening.

Stick with It

While finding solutions for nail psoriasis can sometimes take longer than most patients would like, treatment does typically help to reduce the symptoms of this condition. And according to Friedmann, “The only real way of controlling flares of nail psoriasis is to control the overall systemic disease process.” That means working with your doctor to find the treatment—or combo of treatments— that best works for you, addressing the underlying disease, and returning your nails to a healthy condition.

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